Background: While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes. Purpose: To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR. Study Design: Case series; Level of evidence, 4. Methods: We evaluated UCLR patients who were nonprofessional baseball athletes aged <25 years at a minimum of 5 years postoperatively. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire. Results: A total of 91 baseball players met the inclusion criteria, and 67 (74%) patients were available to complete the follow-up surveys at a mean follow-up of 8.9 years (range, 5.5-13.9 years). At the time of the surgery, the mean age was 18.9 ± 1.9 years (range, 15-24 years). Return to play at any level was achieved in 57 (85%) players at a mean time of 12.6 months. Twenty-two (32.8%) of the initial cohort returned to play at the professional level. Also, 43 (79.1%) patients who initially returned to play after surgery reported not playing baseball at the final follow-up; of those patients, 12 reported their elbow as the main reason for eventual retirement. The overall KJOC, MEPS, and T-A scores were 82.8 ± 18.5 (range, 36-100), 96.7 ± 6.7 (range, 75-100), and 91.9 ± 11.4 (range, 50-100), respectively . There was an overall satisfaction score of 90.6 ± 21.5 out of 100, and 64 (95.5%) patients reported that they would undergo UCLR again. Conclusion: In nonprofessional baseball players after UCLR, there was a high rate of progression to higher levels of play. Long-term PRO scores and patient satisfaction were high. The large majority of patients who underwent UCLR would undergo surgery again at long-term follow-up, regardless of career advancement.

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: Navicular fractures are commonly seen midfoot fractures that can be easily missed and difficult to treat. More severe fractures result from forces that compress the talar head into the navicular causing the navicular to displace radially like staves of a barrel. In a case report from Foot and Ankle International, Naidu and Singh (2005) showed a displaced comminuted intra-articular navicular fracture that was treated innovatively with a cerclage wiring technique. To our knowledge, this is the only published report of a navicular fracture treated with this approach. Since that time the senior author has treated over 25 of these severe fractures with a similar cerclage wiring technique. Over time this technique has evolved and now preferentially involves use of an Arthrex FiberTape cerclage system. Methods: The surgical technique is described as follows. First a small incision is made over the medial pole of the navicular. A lead suture is then passed after subperiosteal dissection along the plantar surface of the navicular and received at a similar incision at the lateral pole. The original technique we employed involved the use of a Dall-Miles cable and cable passer but has been supplanted by the lead suture technique or by using the needle of an Arthrex FiberTape. Once control of the plantar surface is accomplished, subperiosteal dissection is made along the dorsal surface with a Kelly clamp or small periosteal elevator. The lead suture is then delivered to the medial pole which then allows for circumferential control of the fracture fragments. The FiberTape is then passed by pulling the lead suture which delivers the FiberTape circumferentially. This provides indirect reduction by radial compression as it is sequentially tightened. Results: We have performed over 25 cases in a similar manner and in our experience have found this to be the best fixation and reduction technique available (Image 1 & 2). Conclusion: This approach demonstrates a safe, expedient, minimal incision surgical approach that provides optimal fixation of these difficult navicular fractures.

Background Distal radius fractures are one of the most common fractures seen in the elderly. The management of distal radius fractures in the elderly, especially patients older than 80 years, has not been well defined. The purpose of this study was to evaluate operative treatment of distal radius fractures in patients older than 80 years to determine functional outcomes and complication rates. Materials and Methods A retrospective review was performed to identify patients 80 years or older who were treated for a distal radius fracture with open reduction and internal fixation (ORIF). Medical records were reviewed for demographics, medical history, functional outcomes including quick Disabilities of the Arm, Shoulder, and Hand (qDASH), radiographs, and postoperative complications. Results There were 40 patients included for review. Average age was 84 years. The preoperative qDASH score was 69. At 6 months follow-up, the postoperative qDASH score was 13 (p < 0.001). There were five (12.5%) complications reported postoperatively. All fractures healed with adequate radiographic alignment and there were no hardware failures. Conclusion Distal radius fractures in patients older than 80 years treated with ORIF have good functional outcomes and low complication rates. Increased functionality and independence of the elderly, as well as updated implant design can lead to the effective surgical management of these patients. When indicated from a clinical perspective, operative fixation of distal radius fractures should be considered in patients older than 80 years.